Beyond Size: Sonographic Trajectory as a Tool for Surveillance and Surgical Timing in Neonatal Ovarian Cysts-A...

Neonatal ovarian cysts are the most common abdominal masses in female infants and are frequently detected prenatally. Although most are benign and hormonally driven due to maternal estrogen, optimal postnatal management-particularly regarding surgical timing and surveillance intensity-remains controversial. Current decision-making relies primarily on cyst size and morphology, with limited emphasis on longitudinal sonographic behavior.

To evaluate clinical characteristics, management strategies, and outcomes of neonatal ovarian cysts, with particular focus on sonographic trajectory during follow-up and its potential role in guiding surveillance and surgical timing.

A retrospective cohort study was conducted including female infants diagnosed with neonatal ovarian cysts between 2015 and 2025 at a tertiary pediatric medical center. Patients were managed conservatively with serial ultrasound follow-up or surgically, based on clinical judgment and imaging findings. Sonographic trajectories were classified as regressive, progressive, or stable non-regressive according to relative changes in cyst size over time. Clinical and imaging outcomes were analyzed and compared between management groups.

Forty-seven infants were included, with prenatal diagnosis documented in 80.9%. Seventeen patients (36.2%) underwent surgical intervention, while 30 (63.8%) were managed conservatively. Surgically managed cysts had significantly larger cysts on initial postnatal ultrasound compared with conservatively managed patients (median 60.0 mm vs 27.5 mm, p = .001). Regressive sonographic trajectories predominated among conservatively managed patients (21/30, 70.0%), whereas progressive or stable non-regressive patterns were more common in the surgical group (16/17, 94.1%; p < .001). Ovarian autoamputation was identified in 5/17 (29.4%) surgically treated patients, all of whom demonstrated a non-regressive trajectory prior to intervention.

Most neonatal ovarian cysts in this cohort were successfully managed conservatively. Beyond absolute cyst size, longitudinal sonographic trajectory provides additional clinically relevant information that may support individualized surveillance and surgical decision-making.